There's a good editorial in today's NATURE that I would like to comment on. One of the things about government influence over health care is that there can be a comprehensive and at least somewhat impartial look at which medical procedures actually help people. It would be assumed that driving profits would not be the SOLE motivation for this rating in government-regulated health care. In the UK, there is a commission for this work, called NICE.
NICE is widely regarded as a world leader in comparative-effectiveness studies: research that aims to show which of the available medical options is most effective at treating any given condition, and which is worth the money — what US reform opponents might call 'health-care rationing'. Faced with an overwhelming yet incomplete medical literature, most medical professionals welcome NICE's best-practice guidelines on everything from early testing for breast cancer to child nutrition.
Out of control costs are one of the problems we face as a country. WAY too much money is spent in some instances, and in others not enough is spent. How to bring this into balance, so that you don't have people spending thousands of dollars to cure a headache:
Along with over-scanning, over-biopsying, over-blood-working and other diagnostic excesses, fear propels over-treatment. Anytime a physician diverges from standard U.S. treatment protocols, nearly all of which skew toward expensive drugs and surgery, lawsuit-fear looms. "Defensive treatment" strips physicians of clinical judgment, costs billions and leaves patients less healthy, but it's hard to blame physicians who practice it. As one wearily told me, "You never forget your first lawsuit." From Andrew Weil
And http://www.newyorker.com/... can drive up the costs just as surely:
t McAllen Medical Center, I saw an orthopedic surgeon work under an operating microscope to remove a tumor that had wrapped around the spinal cord of a fourteen-year-old. At a home-health agency, I spoke to a nurse who could provide intravenous-drug therapy for patients with congestive heart failure. At McAllen Heart Hospital, I watched Dyke and a team of six do a coronary-artery bypass using technologies that didn’t exist a few years ago. At Renaissance, I talked with a neonatologist who trained at my hospital, in Boston, and brought McAllen new skills and technologies for premature babies. "I’ve had nurses come up to me and say, ‘I never knew these babies could survive,’ " he said.
And yet there’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average.
Nor does the care given in McAllen stand out for its quality. Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.
While at the Same time we still have Murder by Spreadsheet.
Isn't there some way that we could go from this INSANE system to one that is fair and efficient? One way to start would be to implement a system that at least RATES treatment, like NICE.
NICE's decision-making process remains an honest and increasingly open effort to take empirical evidence about clinical effectiveness, and combine it with the value that the British public — not faceless bureaucrats — put on their health and their lives. The available methods for assessing that value do leave something to be desired. NICE asks people to rate various states of health on a numeric scale, for example — a standard technique in medical economics — even though it is hard to know whether such hypothetical assessments are meaningful to people who are facing death in reality. But there are efforts under way at NICE and by other health economists to improve on such methods. And the United States — where comparative-effectiveness research received a $1.1 billion boost from the economic stimulus earlier this year — should contribute to this effort.
Meanwhile, even as Americans — and many British citizens — view the UK health-care system with bemusement, the British look across the Atlantic Ocean with equal puzzlement and sometimes horror. They see Americans dying with cancer and losing their homes because they cannot afford treatments that are not covered by a health insurance plan. Millions of people cannot afford to go to a doctor at all.
That is the nightmare that the American politicians must urgently resolve, and they would do well to stop being afraid of NICE and start taking cost-saving lessons from it.